DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Transcription

1 DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Lori McInerney, RN Chairperson Jim Attwood, RN Member Dennis Curry, RN Member Grace Isgro-Topping Public Member Joan King Public Member BETWEEN: ) GLYNNIS BURT for COLLEGE OF NURSES OF ONTARIO ) for College of Nurses of Ontario ) - and - ) CAROL STEPHENSON for ) Brenda Lee Lacroix ) ) BRENDA LACROIX ) Registration No ) ) ) Heard: June11-14, 2007 AMENDED DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on Monday, June 11, 2007 at the College of Nurses of Ontario (the College ) at Toronto. The Allegations The allegations against Brenda Lacroix (the Member ) as stated in the Notice of Hearing dated December 6, 2005 (Exhibit #1) are as follows: 1. You have committed an act or acts of professional misconduct as provided by subsection 51(1)(a) of the Health Professions Procedural Code in that you have been found guilty of an offence or offences relevant to your suitability to practise, in that you: (a) were convicted of breaking and entering the home of [A] in circumstances involving: (i) (ii) a physical assault by you of [A] involving a weapon, namely, a syringe; and/or [withdrawn];

2 (b) (c) were convicted of breach of a recognizance which required that you refrain from communication with [A], among other things; and, were convicted of mischief in circumstances where you drove a motor vehicle while impaired as a result of alcohol and drug ingestion. 2. You have committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.37 of Ontario Regulation 799/93, in that on or about November 7, 2002, you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, in that you: (a) (b) (c) (d) (e) broke into the private home of [A] and [B]; and/or physically assaulted [A] in her home using your body; and/or physically assaulted [A] in her home using a weapon, namely, a syringe; and/or [withdrawn]; and/or [withdrawn]. 3. You have committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.37 of Ontario Regulation 799/93, in that on or about December 15 and 16, 2002, you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, in that you: (a) (b) communicated with [A] and/or [B] in circumstances where you were the subject of a recognizance which required that you refrain from communication with them, among other things; and/or you drove a motor vehicle while impaired as a result of alcohol and drug ingestion. College Counsel requested that allegations 1 (a) (ii) and 2 (d) and (e) of the Notice of Hearing be withdrawn.

3 Member s Plea The Member admitted the allegations set out in paragraphs #1, #2 and #3 in the Notice of Hearing. The panel conducted a plea inquiry and was satisfied that the Member s admission was voluntary, informed and unequivocal. In addition the panel received a written plea inquiry, signed by the Member (Exhibit # 2). Procedural History Counsel for the College and Counsel for the Member jointly made a motion for a partial publication/broadcasting ban, specifically: a) paragraph [ ] of the Agreed Statement of Facts with respect to Professional Misconduct allegations, such that the words [ ] are redacted in the public version of the Decision and Reasons; and b) appendix A of the Agreed Statement of Facts with respect to professional misconduct Allegations not be included in the public version of the Decision and Reasons. The panel deliberated and made an order granting the relief sought by the parties because the information concerned the Member s health records and was of a confidential nature. Agreed Statement of Facts NOTE: References to exhibits and appendices were inserted by Counsel prior to the hearing and do not reflect actual exhibit numbers assigned in the hearing. Counsel for the College advised the panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts with Respect to Professional Misconduct Allegations, as follows: MEMBER S BACKGROUND 1. The Member obtained her Diploma in Nursing from [ ] College in 1981 and her registration at the College of Nurses of Ontario ("College of Nurses") that same year. She has completed certificates in Nursing Assessment Skills and Critical Care and Emergency Care, as well various courses in the Bachelor of Science in Nursing program at the University of [ ]. 2. Since 1981 the Member has worked at [the Hospital] where she continues to work to the present. In 1984 she became a full time employee. Her work history can be summarized as follows: (a) (b) from 1983 to 1994, the Member worked as a staff nurse in the Intensive Care Unit and on a medical floor; from 1994 to August 2000, and then February 2001 to July 2001, the Member worked as a staff nurse in the Intensive Care Unit and emergency department;

4 (c) (d) (e) up until 2000, in addition to working full time at the Hospital, the Member was also employed by 4 companies to perform insurance medical assessments; from September 2000 to January 2001, the Member was on a six month medical leave of absence; from August 2001 until December 2003, the Member took a second medical leave of absence. 3. From 1986 until going on medical leave in August 2001, the Member assumed the following additional responsibilities at the Hospital: (a) preceptor to nursing students, as well as a mentor/orientator of new staff to the hospital unit; (b) member of the following hospital committees from time to time: [ ]; (c) (d) (e) team leader of a four member team which served as instructors/mentors for the new Cardiac-Telemetry Monitoring System; WHIMIS unit representative at the hospital; organiser of public relations and social events for [the Hospital] Staff Association; and (f) representative for her employer at the French Language Association of [ ]. 4. In addition, from , the Member held the position of treasurer of the local/bargaining unit of the Ontario Nurses' Association. 5. [ ]. She has been involved in [ ] community activities outside nursing [ ]. 6. The Member has practised nursing for 25 years. During that time she has not had any complaints made against her at the College, she does not have any history of discipline or fitness to practise problems, and she has no prior criminal convictions prior to the events giving rise to the present allegations. EVENTS RELATING TO THE ALLEGATION 7. From September 2000 to February 2001, the Member took a six month leave of absence from her duties at [the Hospital] due to [medical] and personal difficulties [ ]. 8. In February 2001, the Member returned to work in the ICU and emergency department at the Hospital. During this month the Member and her [spouse] legally separated after a 20-year marriage. 9. In August 2001, the Member took another extended medical leave of absence from the hospital due to depression. The Member was abusing alcohol but did not recognize her

5 addiction at the time, and was having difficulty coping with the numerous stresses in her life. 10. Throughout 2001 and 2002, the Member continued on her medical leave of absence from work, and was under the care of physicians. She continued to suffer depression, abused alcohol, and was unable to cope. 11. In late November 2001, the Member began an affair with a married man, [B]. The affair ended for a brief period in February 2002 when [B s spouse (A)] learned about it, but resumed thereafter. 12. In November 2002, the Member was drinking heavily. If the Member were to testify, she would say that she believed that [A] was suspicious that the affair with [B] was ongoing, and feared that [A] had been involved in the Member's car being stolen, some items being taken from her home and hang-up phone calls she had received. 13. On November 7, 2002, the Member went to the home of [A and B]. As a result of events which occurred at the house that day the Member was arrested and charged with various criminal offences as will be described in greater detail below. 14. At the Member's criminal trials, the Member did not dispute the following facts as described by the Crown: (a) (b) (c) (d) (e) (f) (g) On November 7, 2002, the Member went to the home of [A and B]. The Member had previously made arrangements with [B] to meet him that morning at an area motel. She knew that [B] planned to leave home at about 7:30 a.m. [A and B] lived in a reasonably remote, rural location about one kilometre from the nearest town, at the end of a long driveway approximately one-half kilometre in length. Their nearest neighbour was about ¾ of a kilometre away. The day before, the Member had marked a path to [A and B s] house through some nearby woods using marking tape. Sometime prior to 7:30 a.m. on November 7, 2002, the Member parked her car on a nearby road and made her way along the path which she had marked through the bush to the [ ] home. The Member had with her various items including camouflage cloth, plastic handcuffs, latex gloves, syringes, two small bottles of Lorazepam, rope, a Swiss Army knife, green flagging tape, medical supplies, pliers, a black handled filet knife in a sheath, and a blue balaclava. The Member entered the [ ] house, which was unlocked. The Member was wearing a Halloween mask. [A] saw the Member enter the house. The Member attempted to order [A] to the floor and to put her hands behind her back. [A] refused.

6 (h) (i) (j) (k) (l) (m) (n) (o) (p) The Member had a plastic toy gun which [A] grabbed. The plastic gun broke in the struggle. [A] pulled off the Halloween mask and recognized the Member. A physical altercation between [A] and the Member ensued. [A] described the Member as being extremely agitated, preoccupied, constantly looking over her shoulder, and at times appearing distraught with a crazed look in her eyes during the physical altercation. The physical struggle went on for approximately two hours. During this struggle, the Member told [A], among other things, that she had an accomplice who was cutting phone lines. Eventually, [A] agreed to sit on the floor and place her hands behind her neck. The Member then tricked [A] into looking away, claiming she had brought some videos with disturbing material on them. When [A] looked away, the Member pulled a syringe from her bag and stuck [A] in the leg with it. [A] pulled the syringe out of her leg and attempted to stab the Member with it, resulting in the syringe breaking. The syringe contained a saline solution with trace amounts of Lorazepam. [A] suffered various injuries from the struggle, which were not of a permanent nature. The Member suffered physical injuries in the altercation as well. At approximately 9:20 a.m., someone knocked on the residence door to inquire about buying a trailer. This diversion allowed [A] to call 911. The police arrived. The Member was still present and was arrested. The Member was charged with various criminal offences and released on terms, including a recognizance which prohibited her from communicating with [A and B] and from being in [ ] unless accompanied by a family member. Blood tests performed on [A] revealed trace amounts of Lorazepam in [A s] blood. Approximately six weeks after the assault, on December 15, 2002, [B] received a telephone call which he suspected was from the Member. The caller hung up, but [B] called the number displayed on his telephone. The first time, the female answerer said she didn t believe she was speaking with [B] and that he was an impostor and hung up. Given the bizarre nature of the first telephone call [B] called back a second time. On this occasion, the male answerer identified himself by his first name and said that the Member had just stepped out, or was not there. He asked [B] to forget about the call. The next day, December 16, 2002, the Member telephoned [B] saying that she wanted to explain the telephone call of the previous day. [B] told the Member that she was not to call his residence and hung up. The Member then sent a fax apologizing for any distress the call may have caused and said that it had been placed by [ ] as a prank. [B] contacted the police. The police spoke with the Member on the telephone that same morning and asked her to surrender herself at the police station.

7 (q) (r) (s) (t) The police went to the residence where the Member was staying to check on her well-being. She had been scheduled to attend in court and had not appeared. The police found a note on a napkin on the table indicating she had gone to [ ] expecting to be arrested. As the police left the residence they saw the Member s vehicle travelling on the road about three houses away from the residence. They turned to stop the vehicle and saw it turn into the driveway of the residence. The police followed the vehicle into the driveway. As they approached, the Member drove her vehicle into the backyard area and stopped the car. The Member verbally identified herself to the police. The police observed that the Member was very disoriented and rummaging around inside the vehicle trying to retrieve her wallet, papers, and her cigarettes. The Member would not look at the police. The police observed and retrieved an open bottle of wine from the centre console of the car and arrested the Member. The Member did not want to exit her vehicle despite numerous instructions to do so. The Member had difficulty exiting the vehicle and had to be assisted in order to stand up. When they searched the Member, the police found on her person a pill bottle and white pills marked Lorazepam. The Member had to be assisted to walk to the police cruiser because she was staggering. She had difficulty getting into the back of the cruiser, and a strong odour of alcohol emanated from the back seat area. The Member told police she had taken eight Lorazepam and five Percocet, as well as alcohol. The police found two more pill bottles in the vehicle which the Member indicated were Gravol. The police took the Member directly to [the Hospital] where she was seen by someone from the Acute Mental Health section of the hospital because she said she had intended to kill herself. The Member was very unsteady on her feet, her eyes were bloodshot, and she had difficulty focussing. She appeared very groggy and her speech was slurred. Following the Member s assessment, the police noted that she had been crying and had difficulty sitting up in bed. A test for the Member s blood alcohol level indicated a reading of 40 milligrams of alcohol in 100 millilitres of blood. The Member was admitted to hospital. 15. As a result of the events of December 16, 2002, the Member was charged with breaches of her recognizance and impaired driving. 16. The Member remained in [the Hospital] for four weeks from December 16, 2002 to January 17, The Member was seen by a psychiatrist while at the Hospital and a referral was made to the [a health centre]. 17. The Member was held in detention following her discharge from [the Hospital]. 18. The Member was admitted to [the health centre] on February 11, 2003 and was discharged on May 13, At [the health centre] the Member was treated for substance abuse and completed a three month residential treatment program. During this admission, the Member received psychiatric treatment, rehabilitation and assessments,

8 and participated in the addictions rehabilitation program. Her treating psychiatrist at [the health centre] made a discharge diagnosis prognosis and recommended follow-up aftercare and support. A copy of the discharge summary was attached as Appendix A to the Agreed Statement of Facts with Respect to Professional Misconduct. CRIMINAL CONVICTIONS 19. On February 6, 2003 the Member pleaded guilty to break and enter, contrary to section 348(1)(b) of the Criminal Code of Canada (hereinafter "Criminal Code"), in respect of the events of November 7, 2002, as described in paragraphs 14(a) to 14(l) herein. 20. On July 17, 2003, the Member pleaded guilty to breach of her recognizance, contrary to section 145(3) of the Criminal Code, in respect of the events of December 15 and 16, 2003, as described in paragraphs 14(o) to 14(r) herein. 21. In respect of the convictions described in paragraphs 19 to 20, the Member received a conditional sentence of 10 months imprisonment to be served in the community, seven months of which she was confined to residence, and 24 months probation. Additional conditions included a requirement that she attend and comply with a treatment program for substance abuse and mental health issues. 22. In July 2003, court-imposed restrictions, which did not permit the Member to leave her home unaccompanied, were varied to permit her to travel to receive treatment and support. 23. On November 5, 2003, the Member pleaded guilty to mischief, contrary to subsection 430(4) of the Criminal Code, in respect of the December 16, 2002 incident when she was stopped while driving under the influence of alcohol and drugs. She was sentenced to a fine of $ and 12 months probation. 24. The Member served the "house arrest" portion of her conditional sentence from September 2003 to April 12, She complied with all of the terms of her Conditional Sentence Order in respect of the convictions for break and enter and breach of recognizance which ended July 11, The concurrent 12 month Probation Order in respect of the conviction for mischief expired on November 4, The probation order related to the convictions for break and enter and breach of recognizance expired on July 11, The Member's Conditional Sentence Supervisor and Probation Officers have confirmed that the Member has been compliant with all terms of her conditional sentence and probation. MEMBER S RETURN TO WORK 25. In December 2003, the Member s medical leave of absence from work ended and she returned to work at the Hospital as follows: (a) Commencing in December 2003 the Member worked on a medical floor for 5 months as a staff nurse in a temporary fulltime position;

9 (b) (c) (d) In May 2004 she applied for her present position of "Clinical Care and Discharge Resource Nurse" and was the successful candidate; In January 2007, the Member assumed the role of Clinical Resource Charge Nurse for a newly created Geriatric Medical Unit at the Hospital, in addition to her position as Clinical Care and Discharge Resource Nurse; and Since January 2006 the Member has acted as Wound Care Team Champion (team leader) at the Hospital. EXPERT OPINION 26. The College of Nurses of Ontario has had this matter reviewed by an expert, [ ]. [The expert] obtained her Bachelor of Science in Nursing from [ ] and has been a member of the College of Nurses of Ontario since January 1, [The expert] obtained her Masters of Science in Nursing in 1983 from [ ], and her Ph.D. in 1989 from [ ]. [The expert] began work as a staff nurse in the Psychiatric Unit at [a hospital] in 1965 and ultimately became a Professor in the Department of Psychiatry and the Faculty of Nursing at [ ]. 27. If [the expert] were to testify, she would opine that, based on the facts set out above, the Member s criminal convictions for break and enter, breach of recognizance and mischief are relevant to both the practice of nursing and to the Member s suitability to practice nursing, and that the Member has engaged in conduct in all of the circumstances that would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional. [The expert] would say that based on the facts set out above, the Member s behaviour represents a fundamental violation of the values espoused by the nursing profession in that the Member s conduct was, among other things, violent and abusive. MISCELLANEOUS 28. If the Member were to testify, she would express great remorse for her actions. In July 2003, she provided [A] with a written letter of apology, which she read to [A] in open Court. ADMISSIONS 29. The Member admits that she committed acts of professional misconduct as provided by subsection 51(1)(a) of the Health Professions Procedural Code of the Nursing Act, 1991, c. 32 as amended in that she was convicted of the following offences which are relevant to her suitability to practice: (a) on February 6, 2003, she was convicted of break and enter into the home of [B and A] on November 7, 2002, contrary to section 348(1)(b) of the Criminal

10 Code, in circumstances which involved a physical assault of [A] with both her body and with a syringe which contained traces of Lorazepam; (b) (c) on July 17, 2003, she was convicted of breach of a recognizance which required that she refrain from communication with [A] or any member of her immediate family, contrary to subsection 145(3) of the Criminal Code; and on November 5, 2003, she was convicted of mischief, contrary to subsection 430(4) of the Criminal Code, in circumstances where she drove a motor vehicle while impaired as a result of alcohol and drug ingestion. 30. The Member further admits that she committed acts of professional misconduct as provided by subsection 51(c) of the Health Professions Procedural Code of the Nursing Act, 1991, c. 32 as amended, in that she committed the following acts which would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional: (a) (b) (c) on November 7, 2002 she broke into the private home of [B and A] and physically assaulted [A], including an assault with her body and assault with a syringe which contained traces of Lorazepam; on December 16, 2002 she communicated with [B] in breach of her recognizance which required that she refrain from communication with him, among other things; and on December 16, 2002 she drove a motor vehicle while impaired as a result of alcohol and drug ingestion. Decision The panel deliberated and finds that the Member committed acts of professional misconduct in that the Member has been found guilty of offences relevant to her suitability to practise, namely: breaking and entering the home of [A] in circumstances which involved a physical assault of [A] involving a weapon, namely a syringe; breach of a recognizance which required that she refrain from communication with [A], among other things; and conviction of mischief, in circumstances where she drove a motor vehicle while impaired as a result of alcohol and drug ingestion. The panel further finds that the Member committed acts of misconduct, in that the Member engaged in conduct relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable and unprofessional, in that the Member:

11 broke into the private home of [A] and [B]; physically assaulted [A] in her home using her body; physically assaulted [A] in her home using a weapon, namely, a syringe; and drove a motor vehicle while impaired as a result of alcohol and drug ingestion. The panel further finds that the Member committed an act of misconduct, in that the Member engaged in conduct relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional, specifically, that the Member: communicated with [A] and/or [B] in circumstances where she was the subject of a recognizance which required her to refrain from communicating with them. The panel grants leave to the College to withdraw the allegations set out at paragraphs 1a(ii) and 2(d) and 2(e) of the Notice of Hearing. The panel further orders that paragraph [ ] of the Agreed Statement of Facts with respect to professional misconduct allegations, such that the words [ ] are redacted in the public version of the Decision and Reasons; and that appendix A of the Agreed Statement of Facts with respect to professional misconduct allegations not be included in the public version of the Decision and Reasons. Reasons for Decision The Panel agrees that the facts related to the break and enter, the physical assault involving a weapon, namely a syringe, and the impaired driving conviction are clear and uncontested and that the Member s conduct in this regard would reasonably be regarded by members as disgraceful, dishonourable and unprofessional. As such, the Panel finds the Member committed acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.37 of Ontario Regulation 799/93. The Member s intent regarding the communications with [A] and [B], detailed in allegation 3(a), is not as clear. The panel finds that the fax sent by the Member was an effort to apologize and therefore not disgraceful or dishonourable. However, the panel finds the Member s actions unprofessional in that she breached a court order to refrain from communicating with [A] and [B]. Penalty NOTE: References to exhibits and appendices were inserted by Counsel prior to the hearing and do not reflect actual exhibit numbers assigned in the hearing. The Member and the College made a Joint Submission as to Penalty as follows:

12 MS LACROIX AND THE COLLEGE JOINTLY SUBMIT that, in view of Ms Lacroix s admissions of professional misconduct, the circumstances set out in the Agreed Statement of Facts with respect to professional misconduct, and the circumstances set out in the Agreed Statement of Facts with respect to penalty, the Panel of the Discipline Committee ( the Panel ) should make an Order as follows: 1. Requiring the Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three (3) months of the date this Order becomes final. 2. Directing the Executive Director to suspend the Member s Certificate of Registration for five (5) months. The suspension shall take effect on the date that this Order becomes final and shall run continuously without interruption. 3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member s Certificate of Registration: (a) Commencing immediately, and until such time as [Dr. A] is satisfied that the Member does not pose a threat of safety to clients, and in any event for a period of not less than eighteen months, the Member shall: (i) only practice nursing for an employer where other registered nurses are employed, and will not practice independently or in the community; and (ii) attend for forensic psychiatric treatment and monitoring with [Dr. A] at such frequency as [Dr. A] deems appropriate, but in any event no less than four times per year (once each quarter); and (iii) (iv) (v) (vi) personally bear the cost of the sessions with [Dr. A] (in the sense that she will be personally responsible to ensure that [Dr. A] is paid for the sessions referred to in paragraph 3.(a)(ii) herein, whether by herself or by a third party, but in no event shall The College of Nurses of Ontario be responsible for this cost); and follow the treatment advice and direction of [Dr. A] and shall attend for treatment and/or counselling by other healthcare professionals should [Dr. A] consider it appropriate; and not abuse any substances and shall remain free of alcohol and any controlled or mood altering drug unless such drug is prescribed by a treating physician, and the Member shall only take such prescribed drug after consultation with and the approval of [Dr. A]; and consent to undergo random, supervised urine testing whenever requested by her family physician, to occur not less than once per month; and

13 (vii) advise anyone responsible for the collection and testing of the urine samples referred to in sub-paragraph 3(a)(vi) above, that: A. all urine samples obtained should be immediately measured for a body core temperature of 37 degrees and if not found to be temperature specific then a directly witnessed urine sample must be obtained to replace the sample originally given; and B. all samples must be tested for all psycho-active substances, including alcohol; and C. a second test of the sample is to be done in the event of a positive result; and (viii) authorize the results of any random urine testing performed pursuant to paragraph 3.(a)(vi) to be released to both the College, and the Member s family physician; (b) provide to [Dr. A] copies of the following documents: (i) (ii) [Dr. B] s reports dated May 29 and July 11, 2003; and [Dr. C] s report dated March 13, 2006; and (iii) transcripts of the 2003 criminal court proceedings for each of February 6, July 7, July 17, July 29, August 7, September 12, and November 5, 2003; and (iv) (v) a copy of the Member s certificates of conviction; and the Panel s Penalty Order with the attached Notice of Hearing, Agreed Statement of Facts, Joint Submission on Penalty and any attachments to those documents and, if available, the panel s written Decision and Reasons; (c) the Member shall obtain and deliver to the Director of Investigations and Hearings ( the Director ) of the College, within thirty (30) days from the day the Member s appeal rights end as a result of exhaustion, expiry or waiver, a letter signed by [Dr. A]: (i) (ii) confirming receipt of the documents referred to in 3(b) above; and agreeing, during the time period set out in paragraph 3(a) above, to notify the Director immediately, in writing, if: A. in his opinion the Member s health (mental, emotional or physical) may interfere with her ability to practice nursing safely; and/or

14 B. in his opinion the Member has failed to comply with treatment recommendations made by him; and/or C. in his opinion or based upon information which he receives the Member has failed to comply with any of the terms, conditions and limitations imposed upon her certificate of registration; and/or D. in his opinion, the Member is showing signs of substance abuse; and; (iii) agreeing to cooperate with the College by providing such information as the Director may require to ensure that the Member is complying with the terms, conditions and limitations on her certificate of registration; and (d) (e) (f) (g) the Member shall sign a Consent and/or a Release in the College s favour to enable the College to communicate with [Dr. A] regarding the Member s treatment and her compliance with the terms, conditions and limitations; and the Member shall not substitute another physician for [Dr. A] without first obtaining the agreement of the Director to do so; and the Member shall advise the Director of the name of the Member s family physician; and the Member shall provide her family physician with copies of the following documents: (i) [Dr. B s] reports dated May 29 and July 11, 2003; and (ii) [Dr. A s] report dated October 25, 2005; and (iii) [Dr. C s] report dated March 13, 2006; and (iv) the panel s Penalty Order with the attached Notice of Hearing, Agreed Statement of Facts, Joint Submission on Penalty and any attachments to those documents and, if available, the panel s written Decision and Reasons; and (h) the Member shall obtain and deliver to the Director, within thirty (30) days from the day the Member s appeal rights end as a result of exhaustion, expiry or waiver, a letter signed by the Member s family physician: (i) confirming receipt of the documents referred to in 3(g) above; (ii) in which the Member s family physician agrees to:

15 A. request and conduct supervised urine tests from the Member to be conducted once per month on a random basis; and B. immediately test all urine samples obtained from the Member for a body core temperature of 37 degrees and, if not found to be temperature specific, then to obtain a directly-witnessed urine sample from the Member to replace the sample originally given; and C. order a test for all urine samples obtained from the Member for all psycho-active substances, including alcohol; and (iii) order that a second test of the urine sample be performed in the event that a positive result is obtained with the first sample; and (iv) advise the Director within a reasonable time in the event: A. any of the Member s urine samples obtained pursuant to subparagraphs 3(a)(vi) and 3(h)(ii) and (iii) above test positive for any psycho-active substance or alcohol, and to advise on what date the sample(s) was obtained and whether it tested positive for any substance on one or two tests; and/or B. in his or her opinion the Member s health (mental, emotional or physical) may interfere with her ability to practice nursing safely; and/or C. in his or her opinion the Member has failed to comply with treatment recommendations made by him or her; and/or D. in his or her opinion, the Member is showing signs of substance abuse; and/or E. in his or her opinion or based upon information which he receives the Member has failed to comply with any of the terms, conditions and limitations imposed upon her certificate of registration; and (v) cooperate with the College by providing such information as the Director may require to ensure that the Member is complying with the terms, conditions and limitations on her certificate of registration; and (i) (j) the Member shall sign a Consent and/or a Release in the College s favour to enable the College to communicate with the Member s family physician regarding the Member s treatment and her compliance with the terms, conditions and limitations; and the Member shall not substitute another physician for the Member s current family physician as identified to the Director without first obtaining the agreement of the Director to do so; and

16 (k) for a period of eighteen months following completion of the suspension imposed by the Discipline Committee: (i) notify the Director of the name, address and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position. Notification shall be in writing and sent by verifiable form of delivery, such as courier, the proof of which delivery the Member shall retain; and (ii) only practice nursing for an employer who agrees: A. to receive, in advance of the Member accepting or resuming a nursing position with that employer, the panel s Penalty Order with the attached Notice of Hearing, the Agreed Statement of Facts with respect to Professional Misconduct (without appendices), copies of the Certificates of Conviction pertaining to this matter (appendices B, C and D to the previous document), the Agreed Statement of Facts with respect to Penalty (without exhibits), the Joint Submission on Penalty, and, if available, the panel s written Decision and Reasons; and B. to write to the Director within 14 days of the Member commencing employment to: a) confirm the date the member s employment commenced; and b) confirm the employer s receipt and review of the documents referred to in 3(k)(ii)A, above; and c) acknowledge that the employer, and any staff the employer deems necessary, are aware of the restrictions on the Member s certificate of registration; and d) to notify the Director immediately upon receipt of any reasonable information that the Member has failed to meet the professional standards expected of her (including any boundary violation) and/or has demonstrated any signs or symptoms of substance abuse, including and in particular any signs of unusual or repeated absenteeism and/or lateness; and (l) in the event the Director or his or her delegate receives information from which she or he forms a reasonable belief that the Member s health may be affecting her ability to practice nursing safely or that she has failed to comply with any of the terms, conditions and limitation imposed on her certificate of registration, the Member shall consent to the Director or his or her delegate contacting the Member s employer(s) and/or [Dr. A] and/or the Member s

17 family physician to obtain information to determine whether the Member s health is affecting her ability to practice nursing safely; and (m) (n) the Member shall authorize employer(s) and/or [Dr. A] and/or the Member s family physician to speak freely with the Director or his or her delegate about any issue or topic, including any issue or topic which would otherwise be confidential; and the Member shall not do anything which would detrimentally affect her employer s or physicians ability to comply with the agreement(s) referred to above. In addition, College Counsel and the Counsel for the Member presented the following Agreed Statement of Facts with Respect to Penalty (Exhibit #4 Tab A). Member s After-Care & Recovery Program 1. Since her discharge from [the health centre] in May 2003, the Member has received the following treatment and counselling: (a) From July 2003, to approximately March 2004 the Member received individual counselling with an addictions counsellor at [ ], initially on a bi-weekly basis, and subsequently monthly; (b) From July 2003 to approximately March 2004, the Member attended sessions with a social worker on a bi-weekly basis until the fall of 2003 and subsequently monthly; (c) The Member has attended for family counselling; (d) From July 2003 to April 2004, the Member attended every two weeks for individual psychotherapy from [Dr. D], a physician who specializes in addiction counselling for health professionals. Since May 2004, she continues to see [Dr. D] as needed; (e) From July 2003 to November 2006, the Member attended sessions of the [ ] which provides group therapy restricted to health professionals. From July 2003 to April 2004, she attended weekly sessions, and thereafter bi-weekly sessions until November 2006; (f) Since July 2003, she has attended meetings of a substance abuse support group on a regular basis, and continues to attend these meetings approximately three to four times per week. She is currently very involved in the program and is active in her group chairing meetings and speaking when asked at open meetings; and (g) Since February 2006, the Member has attended counselling sessions with psychiatrist [Dr. A] approximately once per month. 2. If [Dr. D] were to testify he would confirm the information and opinion he has

18 provided in two letters dated April 15, 2004 and May 30, Copies of these letters were attached to the Agreed Statement of Facts with Respect to Penalty as Exhibits 1 & 2, respectively. The Member's Return to Work 3. By letter dated December 15, 2003, psychiatrist [Dr. E] provided his opinion that the Member was stable enough from a psychiatric point of view to return to work. Attached to the Agreed Statement of Facts with Respect to Penalty was Exhibit 3 is a copy of a letter dated December 15, 2003, from [Dr. E]. 4. On December 30, 2003, the Member resumed working at [the Hospital] as a staff nurse on a medical floor in a temporary full time position. A performance appraisal by her supervisor/manager dated April 26, 2004 confirmed she met all expectations in this position. 5. In approximately May 2004, the Member applied for the position of Clinical Care and Discharge Resource Nurse and was the successful candidate. In May 2004, she began working in this position, which is a senior leadership position with focus on coordination of care of medical patients, resource person for staff members and discharge planning of patients. A performance appraisal by her supervisor dated March 26, 2006 confirmed she met all expectations in this position. In addition, the Member is an active member on a number of hospital committees, including medical committees. 6. [ ], the Member s Manager at the Hospital since September 2004, has provided a letter dated April 20, 2007, confirming that the Member is working within the standards expected of her as a nurse since she returned to work in December A copy of that letter, dated April 20, 2007, was attached to Agreed Statement of Facts with Respect to Penalty as Exhibit 4. Member s Apology Letter 7. The Member apologized to [A] during the course of the criminal proceedings in Attached to the Agreed Statement of Facts with Respect to Penalty as Exhibit 5 was a copy of the Member s apology letter dated July Member s Probationary Period 8. The Member s Probation Officers, [ ] and [ ], have confirmed that the Member has been compliant with all terms of her conditional sentence and probation, and all probation orders have now expired. Expert Opinions 9. The Member was assessed by [Dr. A] on April 12 and May 12, [Dr. A] provided a written opinion of his assessment of Ms Lacroix dated October 24, If [Dr. A] were

19 to testify he would provide the opinion set out in a copy of his October 24, 2005 report which was attached to the Agreed Statement of Facts with Respect to Penalty as Exhibit 6. A copy of [Dr. A s] CV was attached as Exhibit The Member s conduct and the written opinion of [Dr. A s] has been reviewed and considered by [Dr. C]. If [Dr. C] were to testify he would provide his opinion set out in his report dated March 13, 2006, a copy of which was attached to the Agreed Statement of Facts with Respect to Penalty as Exhibit as 8. A copy of [Dr. C] s CV was attached as Exhibit In considering [Dr. A] s opinion, [Dr. C] also took into consideration the reports of [Dr. B] dated May 29 and July 11, 2003, which reports were provided in the course of the criminal proceedings with respect to Ms Lacroix s criminal convictions. If [Dr. B] were to testify he would provide his opinion set out in his reports dated May 29 and July 11, 2003, copies of which are attached to the Agreed Statement of Facts with Respect to Penalty as Exhibits 10 and 11, respectively. 12. [Dr. A] has provided two recent reports dated May 14 and May 15, 2007, respectively. If [Dr. A] were to testify he would confirm the information and provide his opinion set out in these two reports. Copies of these reports were attached to the Agreed Statement of Facts with Respect to Penalty as Exhibits 12 and 13, respectively. Member s Documents 13. Attached to the Agreed Statement of Facts with Respect to Penalty were the following documents bearing exhibit numbers to that document as indicated: 14. i) Letters from Treating Professionals Exhibit 14 Letter: [ ], Social Work Department, [ ] Hospital. March 23, 2004 Exhibit 15 [Addiction Treatment Services] Discharge Summary for Case Base, [ ] April 2, 2004 Exhibit 16 Letter: [ ], Family and Child Therapist January 15, ii) Letters from Probation Officers Exhibit 17 Letter: [ ], Conditional Sentence Supervisor December 15, 2003 Exhibit 18 Letter: [ ], Conditional Sentence Supervisor, Probation and Parole Officer March 31, 2004 Exhibit 19 Letter: [ ], Probation and Parole Officer November 21, 2005 Exhibit 20 Letter: [ ], Probation and Parole Officer December 12, 2006

20 iii) Documents from [the Hospital] (Performance Appraisals and/or Letters from Colleagues and/or Other) Exhibit 21 Letter: [Colleague A] August 4, 2003 Exhibit 22 Letter: [ ], Vice President, Clinical Programs April 2, 2004 Exhibit 23 Report of Performance Appraisal April 6, 2004 Exhibit 24 Exhibit 25 Exhibit 26 Letter: [ ], Clinical Director Medical Program, [the Hospital] Letter: [ ], Clinical Care and Discharge Resource Registered Nurse, [the Hospital] [Hospital] Certificate of Recognition (one year perfect attendance record) November 24, 2005 December 20, Exhibit 27 Letter: [Colleague A] January 2, 2006 Exhibit 28 Letter: [ ], Vice President, Patient Services January 13, 2006 Exhibit 29 Performance Appraisal including Director s Performance Planning Worksheet and Selfevaluation component (12 pages) March 28, 2006 Exhibit 30 Memorandum: [ ] May 11, 2006 Exhibit 31 Letter: [ ], Clinical Manager Medical Program November 9, 2006 Exhibit 32 Letter: [ ] February 5, 2007 Exhibit 33 Letter: [Colleague B] (nurse) March 5, 2007 Exhibit 34 Exhibit 35 Exhibit 36 Letter: [ ], Clinical Manager Medical Programs, [the Hospital] [Hospital] Certificate of Recognition (two years perfect attendance) Letter (peer evaluation): [Colleague C], Reg. N. April 28, 2007 Fax date May 18, 2007 Undated Exhibit 37 Letter: [Colleague C], R.N. Undated iv) Member s Professional Development

21 Exhibit 38 Exhibit 39 Typed summary of Member s professional development activities in the years 2004 to 2007 and related certificates of attendance Algonquin College transcript of Academic Record and attached program description for the Ontario Management Development Business Management Skills Certificate program to 2007 May 26, 2006 v) Miscellaneous Exhibit 40 Letter: [ ], Nursing Professor, [ ] College June 17, 2004 Exhibit 41 Thank you to Brenda Lacroix re treatment of [ ]. July 19, 2005 Exhibit 42 Letter: [client A] November 15, 2005 Exhibit 43 Letter: [client B] December 5, 2005 Exhibit 44 Letter: [client C] December 5, 2005 Exhibit 45 Thank you card: [client D] September 2006 Exhibit 46 Letter: [Client B] January 2007 Exhibit 47 Thank you letter: [ ] and [ ] March 2007 Exhibit 48 Exhibit 49 Card: Thank you to Brenda for caring for [ ]. Handwritten note: Thank you to Brenda while [ ] was in hospital. Undated Undated Exhibit 50 Card: Thank you to Brenda and [ ] Undated Exhibit 51 Thank you card: Family of [client F] Undated It was the submission of College Counsel that the penalty provides specific deterrence to the Member and general deterrence to the membership. It ensures protection of the public and provides for remediation, rehabilitation and monitoring of the Member s behaviour. College Counsel submitted that the criminal acts the Member engaged in were egregious and contrary to the ethics of nursing which are based on helping not hurting. Counsel referred to four previous discipline decisions to demonstrate that the five month suspension was within the appropriate range. College Counsel submitted the following aggravating factors for the panel s consideration in assessing the Joint Submission as to Penalty: the events of Nov. 7, 2002 were pre-planned. The Member had marked a route through

22 the woods to the [A and B s] home the previous evening and had ensured that [B] would be away from the house. She brought a number of items including a syringe and then entered the house wearing a mask; the attack on [A] was a violent, physical assault; and the Member used a syringe, which she was able to access through her nursing workplace, as a weapon. College Counsel also submitted a number of mitigating factors for the panel s consideration of the Joint Submission as to Penalty, which included the fact that the Member: had no previous criminal history or findings at the College; the Member had admitted her professional misconduct and was cooperating fully with the College; the Member had shown remorse by her letter to [A] (Exhibit #4, tab 5); the member had served her criminal sentence without incident; continues to live with a measure of public scrutiny; had made considerable efforts to rehabilitate (Exhibit #4, tab A); and has returned to work at the hospital where she had worked for over 25 years and has had 3 ½ years with good performance appraisals, including a promotion. Additionally, College Counsel submitted that this was a single incident involving the member and at the time of the incident the Member suffered from depression and [substance abuse issues]. College Counsel cautioned the panel against putting too much weight on the reference letters which were included in Agreed Statement of Fact with Respect to Penalty (Exhibit #4). She stated that letters of reference should legitimately speak to the Member s character but not to the penalty. Counsel for the Member agreed that the penalty was appropriate for these particular circumstances considering the Member s background, personal circumstances at the time of the event, mental health at the time of the events, and the treatment, counselling and remediation undertaken by the Member. Counsel for the Member submitted that the experts opinions regarding the Member s current mental health and work performance should be considered by the panel. Counsel for the Member submitted mitigating factors should be taken into account by the panel in considering the Joint Submission as to Penalty, such factors included the fact that the Member: had no previous history with the College or the Courts; has co-operated fully with the College; was suffering from depression and [substance abuse issues] at the time of the event. Counsel made extensive reference to the opinions [Dr. A], a forensic psychiatrist, and [Dr. D], an addictive disorders specialist; has had a 25 year career at [the Hospital] although she was on leave at the time of the event; had acknowledged her guilt both to the Courts and the College;

23 had served her sentence without incident; 10 month conditional sentence, 2 year probation and $600 fine; has engaged in a significant After-Care and Recovery Program; (Exhibit #4, Tab A); has had 3 ½ years of successful work performance at [the Hospital] since the incident; and current health status, as reported in a letter dated May 30, 2007 from [Dr. D] in which he found the Member fit to practise nursing responsibly, safely and ethically. Additionally, Counsel for the Member submitted that the incident was out of character both professionally and personally. Counsel referred the panel to letters written by [Colleague A] and [Colleague B,] who have worked with the Member for over 25 years. As well, four and one-half years have passed since the incident and the Member has maintained sobriety. After considerable deliberation, the panel requested both Counsels to make further submission respecting the appropriateness of the lengthy 5 month suspension proposed in the Joint Submission as to Penalty College Counsel stressed the seriousness of the offence, stating the importance of sending a strong message, through penalty, to the Member and to the membership at large. She reminded the panel that this was a Discipline, and not a Fitness to Practice, hearing. In her submission, she submitted it would be the wrong approach to suspend all or part of a suspension for the reason that a member suffered from mental illness at the time of the offence, but, by the time of the hearing, had been rehabilitated. She said there was nothing in this penalty detrimental to the Member s recovery and that the Member would be able to continue her nursing career after serving the suspension. College Counsel drew the attention of the panel to the case of R. v. Dewald, [2001] O.J. No (QL), in which the Ontario Court of Appeal considered the benchmark to be used when considering changes to the terms of a Joint Submission as to Penalty. The key point made by the Court in that case was at para. 29,.Judges may reject a joint submission if accepting it would be contrary to the public interest or would otherwise put the administration of justice into disrepute. In summary, College Counsel reinforced the point that the Panel had a joint submission before it, signed by the Member. Counsel for the Member also reiterated that the penalty was submitted by both parties. However, she did remind the members of the panel that they were to weigh all the facts when considering the penalty. With regard to the Dewald case, Counsel for the Member drew attention to a point made in dissent by the Judge J.A. Carthy at para. 24: General deterrence becomes a modest concern because parents in this state of depression do not think rationally about the consequences of their acts. Rehabilitation becomes a more